The influence of gender on the outcome of coronary artery bypass surgery.

BACKGROUND: To assess the impact of gender as an independent risk factor for early and late morbidity and mortality following coronary artery bypass surgery. METHODS: Perioperative and long-term data on all 4,823 patients undergoing isolated coronary bypass operations from November 1989 to July 1998 were analyzed. Of these patients, 932 (19.3%) were females. RESULTS: During the years 1989 to 1998 there was a progressive increase in the percentage of women undergoing coronary artery bypass surgery. The following preoperative risk factors were more prevalent among women than men: age above 70, angina class 3 or 4, urgent operation, preoperative intraaortic balloon pump usage, congestive heart failure, previous percutaneous transluminal coronary angioplasty, diabetes, hypertension, and peripheral vascular disease (all p < 0.05). Men were more likely to have an ejection fraction less than 35%, three-vessel disease, repeat operations, and a recent history of smoking. Women had a statistically significant smaller mean body surface area than men (1.72+/-0.18 versus 1.96%+/-0.26% m2). On average, women had fewer bypass grafts constructed than men (2.9%+/-0.8% versus 3.2%+/-0.9%) and were less likely to have internal mammary artery grafting (76.2% versus 86.1%), multiple arterial conduits (10.1% versus 19.8%), or coronary endarterectomy performed (4.9% versus 8.6%). The early mortality rate in women was 2.7% versus 1.8% in men (p = 0.09). Women were more prone to perioperative myocardial infarction (4.5% versus 3.1% p < 0.05). After adjustment for other risk variables, female gender was not an independent predictor of early mortality but was a weak independent predictor for the prespecified composite endpoint of death, perioperative myocardial infarction, intraaortic balloon counterpulsation pump insertion, or stroke (8.55 versus 5.9%; odds ratio, 1.30; 95% confidence interval, 0.99 to 1.68; p = 0.05) Recurrent angina class 3 or 4 was more frequent in female patients (15.2%+/-4.0% versus 8.5%+/-2.0% at 60 months, p = 0.001) but not repeat revascularization procedures (percutaneous transluminal coronary angioplasty, redo) (0.6%+/-0.3% versus 4.1%+/-0.8% at 60 months). Actuarial survival at 60 months was greater in women then men (93.1%+/-1.7% versus 90.0%+/-1.0%), and after adjustment for other risk variables, female gender was protective for late survival (risk ratio, 0.40; 95% confidence interval, 0.16-0.74; p < 0.005). CONCLUSIONS: Perioperative complications were increased and recurrent angina more frequent in women. Despite this, late survival was increased in women compared with men after adjustment for other risk variables

Emollient applications for chronic skin problems.

Emollients soothe and hydrate the skin. These products are the mainstay of treatment for contact dermatitis. Nurses do not need to be experts in dermatology but they do need to understand the principles and be able to advise on treatment options.

Handwashing solutions.

Handwashing is the most vital of all nursing procedures. Nurses can influence practice and purchasing decisions in handwashing. All the costs of handwashing need to be considered when choices are made.

Fluids used in total parenteral nutrition.

Parenteral nutrition is indicated for patients who cannot eat normally and for whom enteral feeding is inappropriate. TPN has an increasing role in home care for long-term conditions. The costs associated with TPN need to be considered in the context of patient benefits.

Two-piece stoma systems.

Two-piece stoma appliances may not be suitable for all patients-- especially those with limited dexterity. For many, these systems can be quick, convenient and economic. The nurse's role is to ensure that the patient has a choice.

Protein and energy food supplements.

Nurses must ensure that they are knowledgeable about nutrition--or the responsibility will be passed to untrained staff. There is a wide choice of food supplements, enabling cost-effective choices to be made.

Devices for measuring blood glucose levels.

Monitoring blood glucose is as essential as ever. Technology has given real freedom to people with diabetes. The aim of diabetes management these days is simply to allow for a normal life. Nurses must keep abreast of all new developments.

Procedure gloves.

The US policy of 'universal precautions' treats all body fluids and excreta as an infection risk. Nurses have a responsibility to understand the rationale for glove use. Gloves play a major part in preventing cross-infection. The wearing of gloves is not a substitute for handwashing.

Reviews.

WOUND MANAGEMENT EDUCATION SYSTEM BODYWORKS 3.0 FOR DOS AND WINDOWS.